Folliculocentric Herpes: A Clinicopathological Study of 28 Patients

Abstract

Cutaneous herpetic eruptions can evoke a predominantly folliculocentric mononuclear cell reaction and vasculitis; there is an association with underlying endogenous and/or iatrogenic immune dysregulation. Most cases are secondary to reactivation of varicella zoster. The histomorphology suggests a role for cell-mediated immunity. Antigenic homology of an endogenous 72-kd heat shock protein in follicles with that of a herpetic heat shock protein, in concert with an intrafollicular proliferative response of γ-δ T lymphocytes, may explain the follicular localization and composition of the infiltrate.

Painful cutaneous lesions on the hand palm after Takotsubo cardiomyopathy and coronary angiography

“…Sometimes, mainly in immunosuppressed patients, VZV displays atypical clinical presentations, making it difficult to diagnose. 1,4 In these misleading manifestations, which include ulcerated, verrucous and necrotic lesions, further studies such as Tzank smear, viral culture, histopathological study and PCR are useful. 1,2,5 Common histological findings in VZV infections include intraepidermal vesiculation or ulcers combined with ballooning degeneration of keratinocytes, along with acantholysis and necrosis.…”

“…Additional cytopathic changes include pale keratinocytes with steel-grey nuclei and margination of chromatin, multinucleated giant cells and eosinophilic intranuclear inclusions. 1,2,4 Usually, VZV changes are limited to the epidermis and/or hair follicles although the sebaceous glands, eccrine glands and dermal vessels can also be involved. 3,4 VZV infection of eccrine glands and ducts is termed HZ with syringitis and represents a rare manifestation of HZ.…”

“…HZ with syringitis has primarily been reported in patients with HIV. 2,4 Some authors have reported a link between the infiltration depth of VZV and the severity of the infection, and therefore, eccrine engagement has been associated with more severe infection and immunosuppression. However, it can also be present in immunocompetent patients.…”

“…Glycoprotein E expression is more persistently found in eccrine than epidermal and follicular epithelium, even when the clinical lesions have healed. 1,2,4 VZV is able to produce vasculopathy as a result of endothelial cell infection that generates inflammation, thickened intima and vascular remodelling. The VZVmediated vasculopathies include capillaritis, granulomatous vasculitis and occlusive vasculopathy.…”

“…Cutaneous manifestations of HZ include pruritus and intense pain, along with grouped vesicles on an erythematous base in a dermatomal pattern. Sometimes, mainly in immunosuppressed patients, VZV displays atypical clinical presentations, making it difficult to diagnose 1,4 . In these misleading manifestations, which include ulcerated, verrucous and necrotic lesions, further studies such as Tzank smear, viral culture, histopathological study and PCR are useful 1,2,5 …”